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You can learn more about how B12 deficiency anemia causes these symptoms from Medical News Today

For example, mixing 10 ml of bacteriostatic water into a 5 mg vial produces a 0.5 mg/ml solution so a "25-unit dose" on a U-100 syringe now delivers only 0.125 mg, half the intended amount

Even brief exposure to ambient temperature accelerates degradation

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[DOI] [PMC free article] [PubMed] [Google Scholar] 276.Krystal J.H., Karper L.P., Seibyl J.P., Freeman G.K., Delaney R., Bremner J.D., Heninger G.R., Bowers M.B., Jr., Charney D.S

A 42 mg vial with 2 mL yields 7 units per injection for the same duration